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Outlier Payment Deficiencies Cripple Small Providers

Published on Fri Apr 20, 2012

Will the next claims system update fix the problem? Question: Is there anything we can do to help with the outlier payment issues that CMS is having? We have outlier payment deficiency on three clients now. We are well under the 10 percent threshold on payments. We are a small agency and these outlier payment issues are becoming crippling. Answer: The Centers for Medicare & Medicaid Services has been issuing system corrections since last October to try to rectify reimbursement problems related to its 10 percent cap on outlier payments. But so far none of the system updates has been effective. The outlier issue is a real problem for some agencies, says billing expert M. Aaron Little with BKD in Springfield, Mo. "We have ... clients in our billing services that are also very adversely impacted by this issue. But, on an overall basis it's such a small issue for [...]
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